ANESTHESIA IN PERIPHERAL VASCULAR SURGERY

区域麻醉或全身麻醉是否相关 伴有较高围手术期并发症的患者 心血管疾病是临床常见的重要问题。 在医学专家中进行了辩论。没有精心设计的潜在客户 已经对这一问题进行了研究，并论证了 目前依赖的证据是坊间的、主观的或 间接证据。以确定硬膜外麻醉(作为一个子集 区域麻醉)和全身麻醉显示出相似的比率 术中和术后心肌缺血，我们建议 200例低位手术患者的随机临床试验 约翰霍普金斯医院的四肢血管移植手术 在四年内。 这项研究的具体目的是(1)比较 围术期心肌缺血、梗死和死亡 患者随机接受硬膜外和全身麻醉；(2) 确定经常发生缺血的高危亚组， 无论采用何种麻醉方法；以及(3)接近和 描述实现预定目标的相对难度 两种技术之间的血流动力学目标。同意 患者将回答一份标准化的病史问卷， 接受身体检查，如果合格，就可以 随机接受硬膜外麻醉或全身麻醉。 在手术中，麻醉技术和 血液动力学管理将由协议规定。 心肌缺血和梗死将通过以下方式确定 从一天开始对96小时动态心电监护记录的评估 术前、术后连续、术后CK-MB同工酶和 心电图均隐蔽为麻醉剂类型。血流动力学不稳定 将根据屏蔽的术中数据记录确定为 超出特定范围的参数插曲和AS关联 控制干预的能力。 多变量分析将被用来开发模型 发生缺血的特定目的是建立 麻醉类型是否是心脏疾病的独立预测因素 终端。

Whether regional anesthesia or general anesthesia is associated with a higher perioperative morbidity in patients with cardiovascular disease is an important clinical issue commonly debated among medical specialists. No well designed prospective studies examining this issue have been performed, and arguments currently rely on evidence which is anecdotal, subjective, or circumstantial. To determine if epidural anesthesia (as a subset of regional) and general anesthesia exhibit comparable rates of intra- and postoperative myocardial ischemia, we propose a randomized clinical trial of 200 patients undergoing lower extremity vascular graft surgery at the Johns Hopkins Hospital over a four year period. Specific aims of this study are (1) to compare rates of perioperative myocardial ischemia, infarction, and death, in patients randomized to epidural and general anesthesia; (2) to identify high-risk subgroups in whom ischemia occurs frequently, regardless of the anesthetic method; and (3) to access and characterize the relative difficulty of achieving predetermined hemodynamic goals between the two techniques. Consenting patients will answer a standardized medical history questionnaire, undergo a physical examination, and then, if qualified, be randomized to receive either epidural or general anesthesia. During surgery both the anesthetic technique and the hemodynamic management will be specified by protocol. Myocardial ischemia and infarction will be determined by evaluation of 96-hour Holter monitor recordings starting the day prior to surgery and serial, postoperative CK-MB isoenzymes and EKGs all masked as to anesthetic type. Hemodynamic instability will be determined from masked intraoperative data records as episodes of parameters beyond a specific range and as incidence of controlling interventions. Multivariate analysis will be used to develop models for the occurrence of ischemia with the specific purpose of establishing whether type of anesthesia is an independent predictor of cardiac endpoints.